Addiction Treatment for the Young Adult by Steven R. Lee, MD

Addiction Treatment for
the Young Adult
by Steven R. Lee, MD
Program Director, Young Adult Addiction Services
3995 South Cobb Drive
Smyrna, GA 30080-6397
(770) 434-4567
I have been blessed to be appointed as the Program Director of
Young Adult Addiction Services. Many people have dedicated themselves to developing this program which upholds the ideals of both
the 12 Steps of Recovery as well as an understanding of the special
needs of the young adult. Anyone who has tried to treat a young
adult with an addiction understands that the young adult does not fit
in with a group of middle age addicts. The young adult has nothing
in common with the older adults except that they all are addicts.
A young adult has a personality that is still in the process of development. Much of the personality has already developed but the
narcissism and idealism of the adolescent still needs to be tempered
through the realities of the school of life. Young adults need specialized treatment because of their age as well as the fact that some of
their personality structure developed due to distortions of reality
because they were using. These “developmental errors” greatly
affect the young adult in relationships and in his ability to function
independently. The inadequate and inappropriate responses will need
to be explained to the young adult in a way that he will not respond
in an angry, defensive manner. Once he accepts that he has these
problems, he will need help to develop better responses.
Standard adult addiction programs are not designed to provide the
structure necessary to confront the young adult’s acting out behavior.
Young adults are not yet capable of controlling and verbalizing many
feelings. Many of these feelings are happening for the first time in
their lives. They express these feelings by acting them out, sometimes
in destructive ways, not fully realizing the consequences of what
they are doing because of their lack of life experience. Unless this is
managed, no addiction program is going to help the young adult deal
with his addiction.
A young adult is a hybrid of an adolescent and an adult. I consider
most young adults in our program to be professional adolescents
since they have not yet taken on the responsibilities of an adult and
have been in graduate studies in adolescent behavior. The oppositional-defiant behavior coupled with the feeling that he is entitled
to free room and board eventually causes the parent to feel disrespected, resulting in anger. The parent, who up to this time has been
intimidated by the young adult’s anger, now has the energy to set
limits on his behavior even though he is an adult. When the parent
will not allow the young adult to do something, such as use the car,
the young adult is insulted. The parent’s concern is that the young
adult cannot be trusted to drive the car sober. The parent wanted to
restrict the car in the past but, now, with this anger, the parent has
the energy to finally say “no.” The young adult then leaves the house
in a rage and with righteous indignation, gets intoxicated to prove
that he can do what he wants to do because he is an “adult.” The
young adult’s pseudo-maturity is a defense mechanism, as he unconsciously knows that he is not prepared to support himself financially,
emotionally or socially. Any addiction treatment program that treats
this age group has to have the experience, the ability and the interest
to deal with this type of behavior.
A young adult does not easily fit into either an adolescent group or a
standard adult addiction group. Usually he is the only 20-year-old in
a group of adults with the average age of 35. The young adult will
quickly use this fact as a reason why an addiction program is not
what he really needs. He cannot relate to the adult stressors of child
care, marriage nor the pressure and responsibility of paying bills
(which he has never experienced).
Recognizing the unique needs of this population, Michael Fishman,
MD and Lori Albert-Walker, MSW, developed a treatment track
in 1996 for young adults struggling with addiction. Over the years,
with the support of talented staff and addictionologists, it evolved
into Young Adult Addiction Services at Ridgeview Institute. This
program is truly an oasis for the young adult and his family in a sea
of other addiction programs that do not meet the special needs of
this population.
The following information is written for parents and adult friends of
the addicted young adult. Please note that throughout this brochure,
the young adult is generally referred to as “he.” This is done solely
for the sake of clarity and simplicity. The program has both males
and females that are together in our group sessions but are in separate living quarters with close supervision. Hopefully, after you read
this, you will have a clearer understanding of what is best to do and
not do in order to support your child. Please take time to consider
this information and start your own recovery from the nightmare
you have been living because of your child’s disease of addiction. We
at Ridgeview are committed to doing whatever is necessary to help
your child and you to find recovery from addictive disease, but it will
require work from all.
— Steven R. Lee, MD
Who is an Addict?
An addict is someone who has a persistent, compulsive dependence
on a substance or a particular behavior even though he has experienced potentially harmful consequences while doing this substance
or behavior. An addiction to a chemical such as alcohol, Xanax or
Oxycontin is called a chemical addiction. An addiction to a behavior
such as binging on food, gambling or inappropriate, excessive sexual
activity is called a behavioral addiction.
The compulsion to use a substance or to do a behavior comes from
an involuntary biological drive located in the pleasure centers of the
brain. Once an addict has had an experience that gives him pleasure,
then the memory of this feeling is attached to the behavior that
caused it. This is called biological conditioning.
“Pleasure” here is defined as any feeling that gives someone a sense
of well-being or relief from anxiety. Pleasure could be the ability to
laugh when someone is actually depressed. It can also be an escape
from a sense of dread when someone is under constant pressure
or fear. Therefore, once the addict discovers that using a substance
provides pleasure, he has set up a biological conditioned response.
Whenever he is in an unpleasant or boring situation, he knows that
by using that substance he can get immediate relief.
Biological conditioning is an involuntary reaction to stimuli. Nature
uses biological conditioning so we do not have to think about the
details of the routine things that we do. This involves at least two
events. One event is the stimulus and the other event is the response
to the stimulus.
An addict generally uses his substance at the same time of the day or
in similar situations repetitively (i.e. happy hour, in the evening, on
the weekends). He develops a routine. After many repetitions, the
brain develops an involuntary reaction to the initial stimulus (biological conditioning). When that time of the day or situation comes
up, the addict has a very strong desire to use his substance. In fact,
if he does not use his substance, he feels like something is wrong. If,
in this routine, he finds that his substance gives him some sense of
well-being or relief of stress, then every time he is stressed, he feels
that he has to have his substance to get relief. When an addict who
has been depressed for the past year, realizes that he is not depressed
when he is using his substance, then his addiction has become not
just a recreational way to get high, but a necessary way to deal with
life. This response will override any concerns about the consequences
of using this substance (i.e. driving intoxicated, unsafe sex). He now
has a functional reason why he has to use his substance.
Addicts use a substance over and over again because initially it makes
them feel good. Though all addicts may not use their substance in
order to deal with a particular stressor, many of the addicted young
adults do. When this occurs, we call this a dual diagnosis, meaning
that these addicts have an addictive disease plus a psychological
problem (i.e. depression or anxiety).
Also, addiction is not caused by an event or a situation. It is not the
result of tragedy in someone’s life or because of the stress of a job.
These situations may make an addiction worse, but they are not the
cause of the addiction. You have to be genetically prewired to be able
to have an addictive disease.
Cigarette addiction is the best example of biological conditioning.
Let’s say that whenever a smoker gets in his car, he has a cigarette.
Assume that he does this multiple times over 6 months or longer.
Then one day he gets into his car and he does not have access to a
cigarette. Driving in his car does not feel right without a cigarette.
He can try to drive his car without a cigarette but he feels that
something is wrong. Chances are he will go out of his way to find
his brand of cigarettes. The same habitual reaction possibly develops
after eating a meal, getting up in the morning, going to bed at night
or dealing with a boring span of time. Smoking a cigarette has
become, for the nicotine addict, a biological conditioned response to
each of the above situations.
When the smoker realizes that he can get temporary relief of anxiety
before a stressful event, such as taking a final examination in a college class, he has to have a cigarette to calm down. For the cigarette
addict, smoking is a compulsive act that has to be done to make the
event complete. This would be the same for someone who is compulsively dependent on alcohol, marijuana, Oxycontin or whatever
other substance is involved.
Eight percent of the general population meets the criteria for substance abuse and dependence but, for young adults, this statistic is
possibly three times higher. In a four-year study of college alcohol and
drug use, “Wasting the Best and the Brightest: Substance Abuse at
America’s Colleges and Universities,” the percentage of students abusing drugs between 1993 and 2005 increased in the following areas:
343 percent for opiates like Vicodin and Oxycontin
93 percent for stimulants such as Ritalin and Adderall
450 percent for tranquilizers like Xanax and Valium
225 percent for sedatives like Nembutal and Seconal
100 percent for daily marijuana use
52 percent for cocaine, heroin and other illegal drugs
The consequences of these increases have resulted in at least the
• 6 percent increase in deaths from alcohol-related injuries
• 38 percent increase in injuries as a result of their own drinking
•21 percent increase in the number of alcohol-related arrests per
• 83 percent of all campus arrests in 2005 were alcohol-related
•An unknown percent of alcohol related rape/sexual assaults were
also problems
(Note: These percentages do not include the events that were
reported as accidents when they should have been reported as
preventable consequences of being intoxicated.)
What is the Difference Between an
Addict and a Non-Addict?
Addiction is a medical illness that some people have and others do
not. Usually an addiction involves an activity that gives pleasure or
instant relief from anxiety. Addicts have memories of what made
them feel good in the past (i.e. alcohol, sex, etc.). This memory can
be made conscious by events going on in the addict’s life or by certain feelings he is having in the present. If he is sad, lonely, anxious
or afraid, the brain remembers a solution that gives instant relief to
deal with these bad feelings which is the use of his substance.
The part of the brain that initially responds to a bad situation or to
a bad feeling is the limbic system. This is the more primitive part of
our brain and it does not necessarily care about the consequences of
what may happen after the addict deals with the bad feeling through
his addictive behavior. In fact, the limbic system does not even have
memories of the consequences. It only remembers what gave relief.
The cortex is that part of our brain that remembers all past consequences of behaviors. The cortex also stores what the person has
learned from other peoples’ consequences that have participated in
the same behavior. Normally, when a person experiences bad feelings,
the limbic system demands that the addict find immediate relief. The
cortex filters these demands by flooding the person’s consciousness
with all of the memories of what happened the last time he decided
to respond in that particular way. The person then has to make a
decision of whether or not he will respond as demanded by the limbic
system. Unfortunately, some substances (i.e. alcohol at large doses)
come with a mechanism that disinhibits the person by not allowing
the cortex to bring to consciousness the possible consequences of that
behavior. The addict then proceeds with his addictive behavior.
Addicts have fewer internal cues (i.e. nausea with alcohol) to set
limits as to how much substance they can use or when to stop a
behavior that gives them pleasure or relief. The addict’s repetitive
use of a substance also causes a progressive increase in tolerance; the
addict has to use larger and larger amounts of his substance in order
to get the same effect he got the first time he used. At large doses of
the substance (i.e. alcohol, Xanax, Oxycontin), the inhibitions of the
mature part of our brain (e.g. do not drive at 100 MPH!) are blocked
and the addict responds to the limbic system’s need for immediate
gratification. The cortex (the rational, objective part of our brain), is
ignored in order to experience that immediate gratification regardless
of the consequences.
Unfortunately, the drive to repeat the same behavior eventually takes
top priority in the addict’s life. Family, school, job, relationships,
God and the law all become secondary to the behavior. Anyone who
tries to prevent the addict from acting upon the compulsion will be
considered the enemy.
Rationalization, minimization and frank denial become well refined
responses to anyone’s questions and concerns. An addict will convince himself that he is righteous in his statements of how others are
interfering in his life. He feels that others are trying to take away his
right to make his own decisions by questioning his judgment and
treating him like a child.
An addict even becomes convinced that his behaviors and use of
substances are necessary to deal with depression, to calm down, be
able to get to sleep or to be able to focus. In reality, if Oxycontin,
alcohol or marijuana were healthy treatments for anxiety, depression
or attention deficit disorder, we would prescribe these substances as a
standard of care for these problems.
Many people in our society who seem to be functioning well on the
surface, suffer from addiction. You do not have to be passed out all
the time secondary to alcohol or doing intravenous heroin in order
to be an addict. You do not have to be a bad person to be an addict.
The reality is that most people with an addiction initially go about
their life as anyone else would. In the early phases of the disease the
addict routinely goes to work or to school then at night uses their
substance. This initial phase of the illness proves to the addict that he
is in control of his use. He has proven to himself that he is capable
of managing and controlling his compulsive behavior. The addict
uses this fact to minimize, rationalize or even flat-out deny that the
behavior is dangerous. A rational, sane person would quickly admit
that this behavior is dangerous and destructive. The addict has a
special type of insanity which is based on the delusion that he is in
control of his behavior and that the behavior is essential in order
to deal with life. He cannot or will not deal with life on life’s terms
without the substance.
Even if an addict is able to stop the compulsive behavior for a period
of time, this does not mean that he is not an addict. The problem for
any addict is not stopping but staying stopped.
What Causes Addiction?
Usually in addiction, there is a genetic variable. This genetic variable
is not a dominant trait, meaning that it does not necessarily pass
directly from generation to generation. There may be multiple genes
involved that all have to come together for one individual to become
an addict. An analogy is that of a slot machine. In order to win the
prize, you have to hit three cherries out of a multitude of other combinations of numbers and other objects that come up in the display
window. One or two cherries out of three windows does not give
you anything. You have to have three cherries to win and the odds of
this happening are low. Addicts are genetically preprogrammed to be
addicts in this way in terms of the combinations of genes that occur
from the parents.
What allows an alcoholic to drink a fifth of whiskey one night and
not get sick, then get up in the morning and go to work? What
allows an opiate addict (i.e. Oxycontin, Roxicodone) to take a
narcotic and get high when 92% of the population taking a narcotic
gets sedated? It all has to do with genetics. You have to be genetically
prewired to be able to use these substances without negative side
effects. Most of the population is not physically capable of taking
large quantities of a substance on a regular basis and continuing
to function. Typically, people have nausea and vomiting with large
quantities of alcohol. Most have nausea, sedation, constipation and/
or dysphoria with any dose of a narcotic that they would only use if
the need to stop pain outweighed the side effects.
An addict cannot prevent himself from being an addict through
willpower alone. In the same way, someone with hypertension cannot
prevent an elevation in his blood pressure by using willpower. A
juvenile diabetic and an epileptic cannot “will themselves” not to
have the physical symptoms of their disease. Living a healthy lifestyle
in terms of what you eat, getting the right amount of exercise and
rest and relaxation all affect these illnesses in a positive way but do
not prevent the illness if they are genetically prewired to have these
illnesses. The old saying, “Just Say No!” does not work.
Addicts do not have to go through a medical withdrawal in order to
be considered dependent. An example of this is the cocaine addict
who binges on cocaine every weekend but is at work Monday
through Friday. He does not go through any withdrawal. All that is
required to be dependent is for the addict to repetitively use his substance even though he knows he has had multiple bad consequences.
He usually rationalizes each time he uses that he will be able to prevent the bad consequence. If during a six-month period someone got
two DUIs, was fired from a job because of poor job performance, fell
down some steps and broke a hip while intoxicated, then that person
is clearly an alcoholic though he may not go through withdrawal if
he stopped his use of alcohol.
The diagnosis of abuse is given when there is no withdrawal symptoms and the person continues to use his substance when there have
been some bad consequences because of his use. The distinction here
between abuse and dependency for the addict who is not having
physical withdrawal symptoms (i.e. weekend binge users) is a subjective call. However, it is based upon as much objective information as
can be obtained concerning the addict’s past history of use and the
consequences of the use.
Addiction is a medical illness. While not an excuse for his behavior,
an addict is born preprogrammed to be an addict. This is not a
conscious choice. That said, an addict is totally responsible for all of
the consequences of his addiction. Addiction is not caused by someone else’s behavior. Addiction is not caused by being abused in the
past, having a poor support system, being raised in the ghetto, being
a spoiled brat, a bad kid or being weak and lazy. All of these issues
may impact how long it takes an addict to get into recovery, but
these factors did not cause the addiction.
Addiction may cause someone to behave badly, but if the person had
an anti-social personality before being active in his addiction, the
addiction is not the cause of the antisocial behavior. With young adults
this distinction is hard to make because many young adult addicts start
their addiction during adolescence, when the personality develops.
What is Recovery?
Recovery is the process of (1) abstinence from your compulsive
behavior, (2) being totally honest with yourself and with others about
who you are, and (3) living a spiritual life integrated as a responsible
participant in our society. Spiritual here means at least recognizing
that there is a power greater than yourself. Recovery requires the
addict to be a whole person, to deal with the past, the present and
the future through self-reflection and to take responsibility for his life.
Abstinence is not the same as recovery. The term abstinence refers
to an addict not using his substance of choice but still doing all of
the same behaviors involved with his addiction. This is sometimes
referred to as b
­ eing a dry drunk. Because of the progressive nature
of the addiction and the defenses used to maintain an active addiction, addicts who stop using but who do not change their addicted
behavior will tend to be angry, rigid and controlling. In fact, it is not
uncommon for friends and loved ones of some addicts to prefer the
addict to continue to use than to just be abstinent. R
­ ecovery means
stopping the substance and then working the steps to repair the
damage created by the addiction. This will require an addict to live a
responsible and totally honest life as he faces the consequences of his
A young adult who is immature either because of his personality,
years of substance abuse or because of past emotional or physical
trauma, takes longer to be in recovery than someone who is functioning at his chronological age. He will need more extended care to be
able to grow into full recovery and to be able to live independently.
We all go through stages of social, emotional and psychological
development. As defined by Erik Erikson, they are as follows:
•At 4 to 6 years old we start the Stage of Industry. This is when a
child begins to try and understand the world around him. He will
ask many questions and try to dismantle things to see how they
work. He will also try to build things.
•The next stage of development starts around 12 years old and
extends to age 18. This stage is called the Stage of Separation and
Individuation. Many adolescents have a hard time during this stage
and will separate and individuate through anger and oppositional/
defiant means. They feel that their parents and the establishment
are idiots and, therefore, must take charge of things themselves.
This is the stimulus that motivates the child to leave the nest
but sometimes they are not ready to fly. The ­mature 18-year-old
understands this fact and does not try to do more than he knows
he is capable of doing.
•The next stage is called the Stage of Intimacy and this runs from
18 to almost 30. During this stage, the new young adult begins to
form relationships that will possibly produce children. The narcissism of a child matures into an adult who begins to take complete
responsibility for his behavior and life. This ability to take responsibility broadens to recognizing that, in an intimate relationship,
he also has responsibilities to other people and maybe for his own
As you can tell, the process of recovery requires that you become a
mature, responsible individual. Those people who are not socially,
spiritually and psychologically functioning at their chronological age
have to deal with these other issues before becoming a fully recovering addict.
Addiction adversely arrests many parts of the development of the
adolescent into an adult; this greatly impacts his ability to become
an independent person capable of existing on his own, separate from
parents and institutions. If he has not reached this stage of intimacy
then he will need to build that part of his personality structure that
did not develop due to the addiction. All of this must occur to be
able to live successfully in recovery, so that he is capable of working
a full-time job, having a long-term, intimate relationship and raising
children responsibly.
The 12 Steps of Recovery
At Ridgeview Institute we use the 12 Steps as the basis of recovery.
The 12 Steps is a guideline by which each addict builds his own
recovery based on each person’s individual needs. This guideline was
developed in the 1930s and has withstood the test of time. No other
approach has been so successful. This is not a religion nor is it a cult.
The first three steps of the 12 Steps involve understanding the principles of powerlessness, unmanageability, higher power and serenity.
These principles have to be integrated before doing more detailed
work on who you are and how you got to this place in your life. If
the addict understands these principles, he will not only be at peace
with himself and his environment but he will have “an attitude of
gratitude” for what he has in his life and for his recovery. The fourth
through eleventh steps involve looking at your life with all of your
shortcomings and developing a relationship with God. Looking at
your personality and how to be honest with yourself and with others
is a core issue. Eventually you make amends for what you did wrong
and accept who you are. The last step deals with helping newcomers.
As an experienced recovering addict, you continue to find fullness
in your life by helping those who are just starting this journey of
• The First Step
“We admitted we were powerless over alcohol and drugs and that
our lives had become unmanageable.”
Simply put, this step suggests that you recognize you have lost the
ability to control your use of alcohol and /or drugs. Regardless of the
many ways you have attempted to drink or use in a socially acceptable manner, you are not able to drink or use drugs without something going wrong. It does not mean that you are stupid, nor does
it mean that you are immoral or bad. It simply means that you have
the disease of addiction, and that all of your efforts to avoid this fact
only allows for the destruction of your life and the lives of those who
love you.
• The Second Step
“Came to believe that a power greater than ourselves could
restore us to sanity.”
The “power greater than ourselves” is called “the higher power.”
At least two or more people helping someone towards recovery is
a “power greater than” yourself alone. More people doing the same
job is even a higher power. People helping people generate an energy
which we call “the spirituality of recovery.”
When an addict starts the process of recovery, his life of addiction
has distorted what most people take for granted such as understanding spirituality. Most people are raised in a particular religion which
is a specific, organized way of worshiping a god. During adolescence,
when he was beginning to abstractly understand his family’s religion,
traumatic events could have occurred. This may have affected his
trust in his parents, in society and in God. Sadly, his understanding
of spirituality is greatly affected by those memories. He may have a
great deal of difficulty giving up control in any way. If he has done
what his religion considered to be sinful things then he may believe
that a condemning God would send him to hell. If he was abused
physically or sexually or always felt emasculated by an overpowering
parent, then showing any weakness such as admitting that there is a
power greater than himself makes him feel too vulnerable.
In order to rebuild the addict’s life, any recovery program needs to
help the addict by breaking down everything into basic units. If you
introduce spirituality as God then you have assumed that the addict’s
understanding of God is loving and supportive, which it may not
be. Understanding God requires spiritual maturity. An addict is not
going to believe anything just because it is written in a book or told
to him by a therapist. An addict will initially only believe in what he
can see, what he can audibly hear and what he can feel both physically and emotionally.
The “higher power” is generated when at least two or more people
help each other towards recovery. The feeling that the addict has in
his heart, when he can support another addict by talking about his
past tragedy, is a real feeling and not a concept or a god that someone told him he should believe in. This feeling is called the “spirituality of recovery” and is the fuel that runs the engine of recovery. It is
real and the addict can feel it. The ­addict has now tapped into energy
that can fill up the hole in his soul that he has been trying to fill up
with alcohol, drugs or other addictive behaviors.
The young adult who has developed a positive relationship with his
religion will find that there is no conflict with the second step and
how he worships God. The second step is simply the principle of
recognizing that there is a power greater than one’s self. In the process of separation and individuation, sometimes the adolescent not
only leaves the nest but also rejects anything that identifies him with
his parents (including the family religion). Recognizing any power
greater than one’s self implies that maybe he does not have all the
answers. We help the addict to see that he does not lose his identity,
which he has struggled so hard to obtain as a separate individual
from his parents. He will see that he can integrate into his identity
those family values that he can embrace and still be a separate
person. It does not have to be an all-or-nothing situation.
Once the addict is living the second step, he quickly begins to feel himself energized by the spirituality of his peers who have found recovery.
He sees that the highs and the excitement of the life of an active addict
is only a temporary solution for dealing with a troubled soul.
This second step offers hope. Once you have accepted the fact that
you are unable to fix your addiction by yourself, the 12 Step program
helps you to see that there is hope for restoring your life. The phrase
“power greater than ourselves” means different things to different
people but there are several basic principles that are common to all
addicts. First, you have to ask for help and second, you have to listen
to what people are saying to you.
Addicts who do not understand the second step may say that they
believe in God and that God is their higher power. The problem is
that they continue to make decisions without trying to integrate any
input from others in terms of making healthy changes in their lifestyle. They really did not listen to what was being said because they
had already made the decision by themselves. In functional terms
they are denying that there is a “power greater than themselves”
and are only giving lip-service to the second step by using God as a
means to rationalize their behavior.
The higher power does not mean that you have to be a Christian,
Muslim or a Jew. We have to recognize that there is a power greater
than ourselves and learn how to be open to it, to ask for it and
integrate it into every decision that is made.
• The Third Step
“Made a decision to turn our will and our lives over to the care of
God as we understood him.”
Having recognized that we need help, this step simply states that we
make a decision to incorporate the principles of the first two steps
into every aspect of our lives. The 12 Steps make no claim to what
your beliefs of God should be. They do not preach any particular
religion. Your religion is between you and your God. Having recognized in the first step that your way did not work and in the second
step that a power greater than ourselves can help, the person makes
a decision to turn his recovery over to this process and to trust in it.
Understanding these steps does not happen in a day. You can read
and memorize the words, but you have to experience and live the
steps with others in recovery to make it work.
Step three is an action step versus steps one and two which are
acceptance steps. In this step you must have the will to turn yourself
over to your higher power, yet realize that this is different than the
self-will which has ruled your life as long as you have been addicted.
This self-will gave you a two dimensional understanding of life as it
related to you and the rest of the Universe. Your life was flat and you
were alone.
As you understand steps one and two, you realize the serenity of not
having to solve the problems of the world. You accept those things
you cannot change because of the realization that there is a power
greater than yourself. You can now let go of those things over which
you had no control. You can now focus all of your strength on those
things that you can change because God has given you the “wisdom
to know the difference” between the two. You do not see yourself
as a failure or as weak; you now feel serenity knowing that you are
where you need to be at this moment.
You, the Universe and God makes your life three-dimensional versus
the two-dimensional life of being an active addict. This realization
of the depth of life gives you not only serenity but gratitude for the
fullness and joy of recovery. It was always there but you could not
see it because you were too busy trying to prove that you could do it
by yourself.
Addiction became your false god and you dedicated your life and
your will to it thinking that you were in control. This temporary
relief to the trials of life through the use of your substance and to the
day to day emptiness of being by yourself, has led you to a dead end.
It is time to make a decision to turn yourself over to a higher power
which is an endless spring of life energy.
What is Relapse?
Relapse is when an addict engages in behaviors he used to do when
his ­addiction was active. A relapse does not necessarily mean that
the addict has used his substance of choice or did his old addictive
behavior. Lies, self-centeredness, isolation, inappropriate anger,
relationships with old using friends and impulsive behaviors are
examples of a relapse. Addicts relapse in multiple ways before they
actually use an addictive substance or do their old, addictive behavior (i.e. gambling, bulimia).
If an addict can become aware that he is in a relapse, is not too
defensive and is open to input from others, then he may have a
chance to prevent using his addictive substance. It is critical that the
addict understand this concept and that he is not ostracized if he
tells you that he has relapsed. All addicts relapse in the early stages
of their recovery. The relapse into old behaviors, from when he was
active in his addiction, allows the a­ ddict an opportunity to deal with
unresolved problem areas.
It only takes one second to relapse using a substance. Once an addict
uses his substance or does his behavior then the relief he gets and/
or the joy that he feels rekindles the drive to do it again and again.
This obsessive/compulsive drive overrides the judgment that what is
happening is destructive.
The critical point after the relapse is not that he has relapsed, but
rather how long he stays in that relapse. Resist unloading your
anger on the addict at this time, if possible. Focus on how to stop
the relapse. If there has been a strong foundation of recovery then
chances are that the relapse will be brief. Continued recovery can
occur without much destruction of the person’s life but every relapse
has its consequences that many times ­cannot be fixed.
What is Pairing?
Pairing is when two or more members of a therapeutic group begin
to have a more personal relationship with each other outside of the
group at large. These individuals begin to discuss more intimate feelings and issues with each other rather than discussing these feelings
and issues with the group. Pairing can be a special friendship because
of similar personalities or it can develop around a feeling such as
anger or love. The mutual support and good feelings that come from
this special relationship distracts the addict from staying focused on
himself. The process of finding himself as a separate person is now a
process of recovery with a dependency on someone else.
The closeness that occurs in treatment because the addict has found
a kindred spirit can create an intimacy that the young adult has not
ever experienced. This intimacy does not mean that this relationship is based on the best match in terms of developing a long-term,
intimate relationship. This feeling of closeness (because everyone in
the group knows each other’s most taboo secrets) is deceiving. The
newcomer to recovery still has many ­internal and external battles to
fight, and at this point in recovery, getting into a sexual or emotional
bond with someone stops the process of recovery. It is easier to bond
around this superficial intimacy than to deal with the self (with all
of its guilt, shame and feelings of inadequacy). The joy and excitement of life that results from the initial part of this pairing feel like
a welcome relief. There is not much difference in this situation with
that of relapsing on his substance of choice. Both give him immediate relief and both prevent him from developing into a responsible,
mature adult. We will help the young adult to not substitute another
addiction for the one that brought him into the treatment program.
Remembering the past and making changes in one’s life is hard work.
The addict is quick to find many ways to avoid the pain of selfreflection and dealing with past emotional/physical/sexual trauma.
Learning how to be honest about who you are and what you have
done is not easy.
In the worst-case scenario, pairing ends up in sexual activity and
an attempt at an intimate relationship. This is the blind leading the
blind. The ego of the addicted young adult has parts that are either
broken or have not even developed. When an addict, who is not in
full recovery, forms an intimate relationship with another addict,
who is not in full recovery, that relationship is a house built on sand
that will quickly wash away with the first major storm. Both young
adults involved will add this failure to the list of the other failures
in their life. Since each feels that s/he is a hopeless case anyway, then
s/he may say, “Why not at least feel good?” resulting in using the
substance of choice.
Pairing in terms of special friendships weakens the group because the
group knows that there are secrets. When the group has secrets, there
is a breach in trust and the group members will not feel comfortable
bringing up sensitive issues. Now that at least a couple of the group
members have paired off, each one involved in this pairing will not
be objective with each other for fear of what the other person might
think. This loss of neutrality works either in supporting the other
person when that individual is clearly wrong or is used in anger
towards him when the other person in the pairing feels rejected.
The information kept in trust in the pairing relationship is also not
processed in the open light of day and therefore not fully worked
through. There is always room for misunderstandings and another
opportunity for the addiction to thrive through denial, minimization
and rationalization very much like a bacteria growing inside of the
addict’s soul until it develops into a major infection (causing relapse
into his active addiction).
We recognize that the young adult is in the developmental stage
of intimacy and it will be very hard for two individuals who are
attracted to each other to resist pairing off. Because of this biological
fact, it will take much effort from family and friends not to collude
with the addict over this issue. This may seem like a Victorian idea
but if the patient pairs off with someone, then he will not be able to
stay focused on his own recovery and will relapse.
How Long Does It Take?
An addict between the ages of 18 and 26 (who is functioning at his
chronological age) requires four to six months of structured treatment
before he can return to his normal life (full time employment, school,
pursuing intimate relationships). This is a longer period of time than
it takes for someone older than 26 because the young adult’s personality, and more importantly his maturity, is still a work in progress.
The mature 30-year-old addict ­usually has started his career, has had a
long-term, intimate relationship and has lived on his own.
The first five to six weeks of treatment involve the experiential
understanding and integration of the principles of the first two steps
of the 12 Steps into the addict’s daily lifestyle. This is done through a
partial hospitalization program with a structured residence where the
newcomers to recovery are supervised and directed.
The third step, which starts around the fifth or sixth week, involves
taking what they have learned into real life situations. The addict
moves from R
­ idgeview’s Recovery Residence to a three-quarter way
house in a community outside of Ridgeview Institute. A three-quarter
way house is a halfway house of other recovering addicts that
provides greater supervision than a traditional halfway house.
Around this time is the first major potential for relapse because there is
a change from constant supervision to moving to a three-quarter way
house where there are times when the addict has an opportunity to
be by himself. The young adult may begin to regress to his old ways
of doing things as he unconsciously fears that he is not ready to make
this step outside of having the constant supervision of the Ridgeview
Recovery Residence. Also at this time, the parents are eager to have
their child out of treatment and may feel that the child has learned
the basics of what he needs in order to be in recovery. With their
glimpse of what life can be when their child is sober, there will be
a strong drive from the young adult and from his parents to leave
treatment and to get back into a normal life. Unfortunately, more time
is required for the young adult to integrate this new knowledge.
A good example of the above is the medical student who graduates
from medical school. He is licensed to treat patients. I do not believe
anyone wants this medical student to do surgery on them after only
learning in class the step-by-step procedure to remove a gall bladder. You would probably want that medical student to have done
at least one surgery in a supervised environment before cutting you
open. The recovering addict at this stage of recovery is no different
from this medical student. He has a lot of knowledge but no experience. He has completed the basics of the theory of the first two steps.
Another analogy is that of being an apprentice or intern after graduating from college. Many careers require new graduates to develop
some experience in the real world for at least six months to a year
after graduation before handling complicated situations.
Around the first four to six months of treatment, many of those
recovering addicts can begin the process of reintegrating into their
lives outside of a daily structured therapeutic setting. He can leave
a three-quarter way house and move back home or onto campus. It
will still take another six months to completely change the biological
conditioned responses to life events through a life of recovery versus
the past life of addiction.
For example, an addict who habitually responds to his anxious feelings by using a drug develops a specific, biological response pathway
(stimulus-reaction). It takes a year to “re-program” the brain to form
a new response through repetitive, healthy living. After 3 months,
when he is living his third step, the recovering addict can recognize
intellectually what he needs to do and will change his behaviors
accordingly. However, the response will not come as a natural,
involuntary reaction for a year.
The young adult today is not the same young adult as 30 years ago.
Today, one third of young adults move to a new residence every year
and forty percent move back home with their parents at least once.
They go through an average of seven jobs and two-thirds spend at least
some time living with a romantic partner without being married. The
median age to get married in the early 1970s was 21 for women and
23 for men. In 2009 the age climbed to 26 for women and 28 for men.
The young adult’s self-confidence is a paradox both for society and
the young adult. When asked if they are confident that they will get
to where they want to be in life someday, 96 percent say emphatically, “Yes!” When asked if they feel like they are grown up and
ready to be on their own, 60 percent say that they feel both grown
up and “not-quite-grown up.” Most young adults charge into life
being told that they can do anything they want to do. They are
taught through television, their parents and at school to stand up for
themselves and demand that they will only accept the best that life
has to offer. Many young adults find out through the school of hard
knocks that the best has to be earned through many years of hard
work and experience. Having an attitude of gratitude for what you
have versus an attitude of always wanting more is a lesson that many
young adults do not understand before they come into treatment.
Many young adults, unfortunately, are disrespectful to their elders
and focused on themselves. Most often this is the result of ignorance
and not because they have a selfish personality. The prosperity of the
baby-boomers gave parents of young adults the means to give their
children opportunities that they did not have. The young adult often
takes these opportunities for granted because they did not earn them.
On the other hand, lay-offs, unemployment and being transferred all
over the country (when they finally get a job), was not the environment of the baby boomers when they were young adults. These facts
create great fear, anxiety and frustration for the young adult. There
is a constant feeling of uncertainty in this generation, yet they have
been told all of their life that they could do anything since they have
been given so many opportunities. Even the young adults who have
worked hard and obtained a college d
­ egree many times have to move
back home because they cannot find a job.
The NIMH (National Institute of Mental Health) did a study that
began in 1991. Neuroscientists once thought that the brain stopped
growing shortly after puberty, but this study pointed out how the
brain keeps maturing well into the 20s. Five thousand children from
ages 3 to 16 were assessed and they found that their brains did not
fully mature until age 25. The most significant changes that took
place were in the prefrontal cortex and cerebellum. These areas of
the brain are the regions involved in emotional control and higherorder cognitive functioning (problem solving).
As the brain matures, one thing that happens is the pruning of the
synapses. The synapse is a microscopic area in the brain where one
neuron connects to another neuron or where one idea connects with
another idea. This is necessary for problem solving. Synaptic pruning
does not occur randomly. It depends on how any one brain pathway
is used. By cutting off unused pathways (pruning), the brain eventually settles into a structure that is most efficient for that person, creating well-worn grooves for the pathways that the person uses most.
Synaptic pruning intensifies after rapid brain-cell proliferation during
childhood and again in the period that encompasses adolescence and
the 20s. The longer the young adult is active in his addiction during
this pruning, the harder it will be to change patterns of behavior.
NIMH scientists also found a time lag between the growth of the
limbic system (where emotions originate) and the prefrontal cortex
(which manages those emotions). The limbic system explodes during
puberty, but the prefrontal cortex does not develop as fast as the
limbic system. This area of the brain keeps maturing for another 10
years. This means that emotions might outweigh good judgment for
some young adults, especially if they are intoxicated. The limbic system is where most drugs and alcohol do their work. When the addict
uses his substance and gets relief from stress or feels extra good, the
limbic system records that memory. The limbic system then drives the
young adult back to that substance again and again. Unfortunately,
without having more comprehensive experiences in life, there is not
enough knowledge to appreciate the real dangers of driving a car too
fast or having unprotected, inappropriate sexual activity.
The one thing that insurance companies know is that the risk factors
(and higher premiums) for unmarried, young adults 25 years old
or younger, are much higher than for older, married adults. This is
derived from actuarial data clearly noting that the number of accidents and traffic violations are dramatically higher for teenagers and
young adults.
The process of recovery is repetitively practicing healthy coping skills
with other addicts who are also in the recovery process. In the same
way that a musician has to learn how to make the right sounds from
his instrument without thinking about where to specifically put each
finger for every note, an addict has to know how to respond to life
situations without his substance. Daily attendance of 12 Step meetings along with meeting with a sponsor will finally replace the old
lifestyle that supported an active addictive disease. Knowledge by
itself does not mean that an addict is in recovery; it takes continued
practice. There is not a medication or a short cut for redeveloping
biological pathways in the brain except for repetitive practice in the
school of life “one day at a time.”
Summary of the Program
In our experience of working with young adults, we have come up
with what is necessary for a young adult to be in recovery and make
it stick. I wish that this process could be done in a shorter period of
time but that is not in our hands. Time must be allowed for these
new skills to truly become integrated.
Young adults with oppositional/defiant problems, unstable psychological problems and basic immaturity require more time in treatment than what is provided in the Ridgeview Young Adult Program.
Once they are initially stabilized at Ridgeview, these young adults
need “extended care” which is a residential treatment program
which takes from six months to a year to stabilize these problems so
that the addict can then deal with the principles of the 12 Steps. The
young adult may also have to work through past emotional, physical
and sexual traumatic events that continue to set them up for relapse.
Phase One of Treatment
A) Pre-contemplation: The addict is not considering change. He
may be aware of a few negative consequences of the addiction but is
unlikely to take action towards change. There is an event (legal, loss
of relationship or of a job or school, near-death experience) but without being forced into treatment, the addict would not start treatment.
B) Contemplation: There is some ambivalence about staying in the
addictive state as more negative consequences occur in the addict’s
life. The addict will at least look into what it takes to be in recovery.
At this stage education can occur. Introducing the disease concept
of addiction, as well as the effects that a substance has on the
brain, may begin to help the addict to see that change is necessary.
Sometimes identifying negative consequences of the addiction, introduction to the 12 Steps of Recovery and living with other addicts
who are doing better because they have changed their lifestyle, will
break through the addict’s ambivalence about treatment.
The young adult will usually require two to three weeks to understand the concepts of powerlessness and begin to realize many of the
ways that his addiction has caused unmanageability in every aspect of
his life. In the first week of treatment, a thorough physical, psychological and environmental assessment is completed. We will meet with
the families to be sure that we have all of the information and begin
the process of giving the families support and direction on how to
deal with their child. Medical screening will be done by our internist
and basic blood work will be done to rule out any potential medical
problems that may be affecting the addiction (e.g. thyroid disease).
Most of the patients also have a dual diagnosis that will require
specific treatment along with the treatment for their addiction.
Depression, anxiety, bipolar illness, post traumatic stress disorder
and/or personality disorders are the main secondary diagnoses. In
general, the major issue during the first week is defining the problems
that need treatment and then beginning treatment.
During this week, newcomers are introduced to the basics of the 12
Steps as well as the biological nature of addictive disease. The disease
concept is explained, not as an excuse for the illness, but as a medical
problem that requires daily focus and attention to remain in recovery.
The physical and psychological symptoms of withdrawal and postacute withdrawal syndrome are explained to help the newcomers
understand what is happening to them. Irritability, disturbed sleep,
cravings for their substance and depression are all part of the postacute withdrawal syndrome.
During this first week, most newcomers either deny that they have
a problem or they believe that they can overcome their addiction
by willpower. Total change of their lifestyle is not what they have in
mind. They just want to know what they need to do and to say in
order to get out of the program.
For those who have been in treatment in the past and have had several relapses, the focus during the first week is to find out what they
missed previously. These returning addicts have to understand all
the individual relapse risk factors which can only be found through
self-reflection and a willingness to receive feedback. The concepts of
powerlessness and unmanageability are explained. This is considered
Step One of the 12 Steps.
Phase Two
A) Preparation: The addict has decided to change and is willing to
consider healthy behaviors versus the unhealthy behaviors of being
an addict. The addict has finally stopped talking and telling everyone
how he is not the problem. He is now listening.
B) Action: Both feelings and negative thought patterns are identified.
High-risk behaviors are seen more clearly for what they are and the
addict begins to make changes in terms of how he lives. The energy
of the group working towards recovery (the higher power) gives
the addict what is needed to find alternative ways of living other
than using his substance or acting out his addictive behaviors. He
is actively listening and asking for direction and incorporating the
higher power of recovery.
It takes two to four weeks to understand that there is a power greater
than yourself alone and to believe that this “higher power” can
restore “sanity” in your life. You finally realize that the repeated uses
of substances (or acting out behaviors) that were so dangerous and
destructive are a form of “insanity.” This is considered Step Two of
the 12 Steps.
Phase Three (IOP/Transition)
The new behaviors of an addict in recovery are established, first, in
terms of knowing what to do, then applying this knowledge in the
classroom of life. Relapse prevention, social pressures, sexual desires
and the prejudice of society towards addiction are some of the issues
that the addict has to learn how to handle. We call this learning to
“live life on life’s terms for better or for worse.”
Turning yourself over to recovery and incorporating the above concepts into your life takes three months when you are totally invested
in giving up your addiction. Less than total investment in the process
never leads to recovery.
At the Ridgeview Recovery Residence, every activity is supervised.
The trial visits outside of the hospital are with the family or to
interview for the three–quarter way house. It takes about five to six
weeks from the start of the program at Ridgeview to be ready to
move to the three-quarter way house. If the young adult were to venture outside of this structure during the first several weeks of treatment, there would be too much of a risk of relapse. For the addict
that wants recovery, this relapse would not be because the addict had
planned the relapse; it would be the result of the involuntary biological response of the old addictive lifestyle triggered by normal events
in life. At this early part of treatment the addict has not had enough
time to understand powerlessness or to substitute healthy reactions,
versus their more familiar, addictive reactions to routine events.
If the addict only has an addiction (versus a dual diagnosis), is functioning at his chronological age, understands and is living the first
three steps of the 12 Steps, then it is time to move to a three-quarter
way house. It is called this because it does provide more structure
and accountability than a half-way house. The experience at the
three-quarter way house takes from three to six months to complete.
If the addict has an addiction but also has a secondary problem that
has not been stabilized, then the team will recommend extended care
in order to continue to provide structure and treatment for this dual
diagnosis young adult. Extended care lasts a minimum of six months
and may be longer depending on the severity of the problem. This
takes place outside of the Ridgeview program.
I realize that what has just been described may be hard to take in since
most parents and young adults are expecting addiction treatment to
take about a month. Most parents will say, “Surely, there has to be a
way to do this treatment in a shorter period of time.” Chronologically,
the young adult should either be in college or have finished college
and have a job. I wish treatment could be done in a shorter period
of time but there is no way to speed up the process of changing the
addicted biological conditioned-response pathways in the brain.
Phase Four (Maintenance)
Living life as an addict, now in the early stages of recovery, takes
practice. Taking a part time job and/or being in school part time are
ways that an addict may experience relapse risk factors that he did
not expect. Daily 12 Step meetings and meetings with his sponsor
give him the answers to deal with these factors. If the addict does
well in the transition from the Ridgeview Recovery Residence to the
three-quarter way house, then he will be moved to an IOP (Intensive
Outpatient Program) within about a week. The difference in an IOP
from the PHP is a matter of hours per day of scheduled programming. The IOP is the same program as the PHP but the young adult
is in the program from 9 AM until noon. Usually after two weeks of
IOP, the patient is ready to be discharged from the formal program at
Ridgeview. Living in the three-quarter way house takes at least three
to six months in order to practice this new way of living. While living at the three-quarter way house, the addict stumbles over relapse
risk factors in the laboratory of real life, either at work or in school.
There is always someone available to support and help him think
through problems.
Aftercare occurs after the recovering young adult has successfully
completed the program at Ridgeview and is in the three-quarter way
house. The day-to-day struggles of being on his own can cause the
young adult to start to regress into old ways of doing things, which
will be a major relapse risk factor. Coming back to Ridgeview for
the transition groups as part of their aftercare program can give
the support, direction and even confrontation necessary to keep the
recovering addict from drifting into old patterns of behavior. Issues
with job, school and relationships have to be discussed to be sure
that the addict is living a life of recovery. He will meet with the other
alumni of the Young Adult Addiction Program who have gone down
the same road of temptations and fears of dealing with life honest
and sober. Also, parents and other family members are expected to
attend the family alumni group to obtain support and direction.
All adults need at least a year to completely change the addictive
involuntary responses to life situations. It is critical that every reaction in a person’s life be examined. If the newcomer to recovery
avoids dealing with something in himself or in his past that he had
tried to deal with through his addiction, the young adult will stumble
and relapse when that obstacle presents again.
Timeline Summary by Week
Weeks 1 & 2
A) Orientation, expectations, medical screening, blood and urine lab
work, family assessment, psychiatric assessment, medication, addiction assessment, past emotional, physical and sexual trauma assessment, and eating disorder assessment.
B) Begin Step One of the Twelve Steps; concepts of powerlessness
and unmanageability (admits there is a problem and recognizes
C) Basic education of life skills including how to eat right, sleep right
and exercise. Smoking as an addiction, respect for others and their
property, appropriate relationships with the opposite sex and basic
responsibilities in life are all discussed.
Week 3
Step Two: recognizing that there is a power greater than himself and
being open to this power; spirituality as a part of his life.
Week 4
Usually by now the young adult is ready to interview for a threequarter way house, or it will be clear that he needs “extended care.”
Week 5
Step Three is the clear understanding of Steps One and Two. Living
Step Three takes practice by working the first two steps with ­others
in recovery. Move from the Ridgeview Recovery Residence into
three-quarter way house.
Week 6
Start IOP (Intensive Outpatient Program) and begin interviewing for
part-time job or applying for school.
Week 7
Begin part-time job or school.
Week 8
Discharge from Ridgeview program. High potential for relapse unless
working program diligently. Faced with enough free time to develop
intimate sexual relationships versus staying focused on his recovery.
The addict has to do one or the other because he cannot do both.
Week 12
Begin working Step Four which requires that the addict is solid in
the first three steps. The risk here is that, if he is not solid in the first
three steps, then as he reviews his past, he may relapse because he
will not be able to deal with the shame and guilt of what he did as an
active addict.
Week 16
Some recovering addicts are capable of leaving the three-quarter way
house and moving back home while others need to stay longer.
Our ideal in the treatment of an addict is to rely on the 12 Steps to
lead the patient into a full recovery and to not use any medication.
If the patient has a dual diagnosis involving a biological medical
problem such as an anxiety disorder, then sometimes we do have
to use medication to treat this problem which is separate from the
addiction. If we do not treat this medical problem appropriately, it
may be the risk factor that will cause a relapse.
Some medications will cause an addict to begin to crave his drug
of choice or may direct him to a different substance that will cause
another addiction. We have found this out through observation of
addicts using certain drugs. A craving is the limbic system having a
memory of the feeling of pleasure that occurred when the addict used
a substance. Though this new substance is not the addict’s drug of
choice, the effects of the new substance has some similarity to the
drug of choice.
If an addict has attempted recovery before coming to Ridgeview
Institute and relapsed, we might consider the use of another group
of medications. Naltrexone may decrease the desire to use opiates
and alcohol (craving) by binding with the opiate receptors in the
brain. If the addict uses an opiate or drinks alcohol, then he will not
get the good feeling he has been used to and will have time to then
ask himself if he really wants to continue in the relapse. Antabuse
may cause nausea and severe continuous vomiting if the addict
consumes alcohol. Campral may decrease some desire to use alcohol
and Chantix may decrease the desire to smoke. Both of these medications also bind receptors in the brain so that if the addict drinks
alcohol while on Campral or smokes a cigarette while on Chantix,
he will not get much of the sense of well-being from that substance
and, hopefully, will ask himself if he really wants to continue in the
relapse. None of these medications in this category are opiates; all
are safe for the addict’s use.
The Young Adult Addiction Program does not support the use of
maintenance narcotics such as Suboxone or Methadone. These drugs
do have a place in the overall treatment of addicted patients but our
program is set up to help the patient to obtain complete recovery.
These maintenance narcotics are used when the patient has relapsed
multiple times. Sometimes it is safer for the addict to be on a prescribed narcotic instead of a street narcotic in order to attempt to
regulate the dosage and to avoid the criminal element that sells drugs.
Most young adults have not been in their addiction long enough to
have tried and failed several treatment approaches. Suboxone and
Methadone are alternatives to total recovery once the conventional
treatments do not work. Maintenance narcotics would be the next
step to keep the addict from continuing to be associated with the
drug community. In the acute phase of treatment these drugs may be
used for medical detoxification. When used this way the drug will be
tapered down and discontinued.
Antidepressants (e.g. Zoloft) and most of the mood stabilizers (e.g.
Depakote) do not adversely affect the recovery process. Most of the
shorter-acting antianxiety medications (e.g. Xanax) are problematic
for an addict as well as the psychostimulants (e.g. Adderall) used to
treat attention deficit disorder. Most of the more effective hypnotics
(insomnia drugs such as Ambien) are also contraindicated. In general
any medication that requires time to build up in the system or that
has a 24-hour or greater action time such as the antidepressants are
not medications that trigger a relapse. Any medication that resembles
the addict’s drug of choice either chemically or in terms of how the
medication makes the patient feel, or any medication (or behavior)
that can give a rapid sense of well-being is contraindicated.
Anyone who loves someone who has an addiction is affected by the
addiction. The family and friends of the addict have experienced a
wide range of emotions. Sometimes they do not even know that they
are having a particular emotion. Depression, anger and anxiety come
and go while they desperately try to deal with the addict’s behavior.
They are either exploding with anger towards the addict or trying to
Parents and Friends
keep the addict’s behavior a secret from others or from themselves
(in order to try and minimize the shame and humiliation).
Some families feel they are walking on eggshells because some
addicts explode in a rage if everything is not perfect or if the family
tries to confront the addict’s behavior. Others run behind the addict
trying to pick up all of the pieces from the destruction caused by the
addict’s behavior. They are hoping that any day now the addict will
see the error of his ways and realize that his behavior is insane.
When the family realizes that this behavior is not going to stop, they
know the addict needs treatment. Unfortunately, the addict usually
disagrees with this conclusion. The family knows that if the addict
would get into treatment for this problem, then this path of destruction could stop. This eventually makes the family “sick” too, as the
family becomes an involuntary prisoner of addiction. The family’s
judgment also becomes clouded because of the emotions that the
addiction causes in others. These include feelings of hopelessness
and despair as they watch their loved one self destruct. Some family
members become constantly angry and feel that their only interaction
with the addict is yelling. The addict may even point out that you
are the one that needs treatment because you are out of control. The
family needs help as much as the addict but in a different way.
The programs of Alanon, Naranon and Codependents Anonymous
are all 12 Step meetings designed to help those who love the addict.
These meetings provide understanding of the disease and support
when they feel overwhelmed and hopeless. They can see how their
attempts to control and change the addict make them sick. They
realize that they are powerless over this illness and that the addict
has to want to be in recovery more than the family wants them to
be in recovery. They realize that until the addict is ready to stop
their addictive behavior, that all other attempts to stop the active
addiction will not work. They learn that they have to take care of
themselves and continue their lives, as they set limits on what they
will and will not tolerate from the addict. Sometimes these meetings
allow the family to heal and other times members of the family need
to also get into individual therapy in order to be strong enough to
help the addict to get into recovery.
Going to one or two of these meetings will not make much of a
difference in how you are responding to your child. You have to go
to multiple meetings over several weeks to months. If you do not
like the people in one meeting then find a meeting with people who
are dealing with the same issues as you. Recovery is a process of first
understanding that you are powerless, then recognizing that there is
a power greater than yourself and then turning yourself over to that
higher power. Our children respond more to our own behavior than
to what we tell them they should do.
Guilt is the feeling that drives a parent to do things that you would
never do if this were not your child. Chances are you loved this child
and did the best you could to be sure that your child had the support
and direction that he needed. However, no matter how objective we
think we are, we still feel guilty if our child has a problem. The fear
that the young adult is in this situation because we must have missed
giving the child something is a normal feeling as a parent. It is just
not true.
Guilt can cause you to enable the young adult by giving him too
many breaks when he needs to feel the full consequences of his
actions. Guilt can cause you to be too angry and hard-nosed in an
attempt to make up for all the times you feel like you let him get
away with things in the past. Guilt can cause you to be too harsh
with your spouse because you irrationally believe that your spouse
should have been stricter with your child. The examples go on and
on. Until you obtain help to better objectify your responses to your
child, all you are doing is making the situation worse. As part of the
addict’s means of distracting you from his problem of addiction, the
young adult uses your behavior as an example of how you, not he, is
the one out of control.
All of this can be very confusing. The parent is not the cause of the
young adult’s addiction. Everyone has to look at their own lives and
get themselves emotionally together in order to deal with this deadly
problem of addiction. Blaming and pointing fingers just takes away
energy that is needed to confront this problem. You cannot overreact
and you cannot under react, but you have to act or this illness of
addiction will continue to destroy the foundation of your child’s life
before he even begins to live it.
Codependency is the behavior of taking care of others at the expense
of taking care of yourself. When your major purpose in life is taking care of someone because that someone does not take care of
himself, you are considered codependent. Even though this gives you
purpose and worth, you can see that eventually you will become
weak and depressed because your needs are not met in a mutual
way by the other person. Taking care of that person enables him to
be able to expand his unhealthy habits requiring the codependent
person to increase his caretaking. This is one way that the addict’s
friends and family may react to try and deal with the addict’s path
of destruction. They hope that the addict will soon see the light and
stop this insanity. In order to keep the family ship afloat and to try
to maintain some normalcy in life, the codependent takes care of
all the background responsibilities while the addict is active in his
disease. Clearly, this is not the way to allow the addict to feel the full
consequences of his behavior so that he may realize the need to stop
his addiction.
A real tragedy is that the family may recognize their own anger just
about the time the addict is feeling good about his recovery. The
family may not be ready to let go of their anger because they now
feel that the addict can deal with it. The family needs time to process
their feelings of anger and depression, which they have unconsciously
held back, for fear that the addict would relapse or just disappear. As
you can see, the family needs treatment just as much as the addict so
that they can recognize all of their feelings at the same time that the
addict is dealing with his feelings. If this is not done, then the family
can be a source of the addict’s relapse in the future.
The Future in Recovery
Addiction is a destructive medical disease that affects not only the
addict, but everyone who has a relationship with the addicted
person. There is no pill and there is no quick fix to treat this disease.
Treatment requires the combined efforts of everyone. This takes time
and resources but treatment does work. The addicted young adult
can take charge of his addiction as long as he can:
• Admit he has a problem (Step One)
•Recognize that there is a power greater than himself (Step Two) by
asking for help and receiving the help that is given to him and by
•Making a decision to integrate the help that is given to him into his
life (Step Three)
There is a positive side to this tragic illness. The addicted young adult
that achieves recovery learns how to cope with life maturely, spiritually and responsibly much sooner than most other young adults. This
life of recovery lays a foundation for healthy relationships and better
responses to life circumstances.
As you can tell, if there is one person in the family that has an addiction, everyone in the family will react to this person’s behavior in a
multitude of ways. If the family does not get their own treatment,
then the family will progressively get more and more sick themselves.
This will not only be a tragedy for the family but it will not help the
addict to get into recovery.
Post Test
1. What is the cause of an addiction?
A. weakness of character, immaturity and irresponsibility
B. inability to deal with stress
C. a major loss in someone’s life
D. A desire to feel good or get high
E. None of the above
2. What is recovery?
A. stopping the substance and making a commitment to not
use anymore
B. stopping the substance causing the problem
C. only using small amounts of a substance on special
D. being totally honest with yourself and with everyone else
3. What are the 12 Steps of Recovery?
A. a book that tells an addict exactly how to live life
B. a special religion that better meets the spiritual needs of
addicts than conventional religions
C. the 12 things to do after you get your first DUI
D. a guideline by which an addict builds his recovery based
on his individual needs
4.On average, how long does it take a young adult to integrate the
first three steps of the 12 Steps into their lifestyle?
A. one week
B. three weeks
C. 28 days
D. three months
5. The term, “biological conditioned response,”
A. is a theoretical reason for explaining why someone
continues to relapse
B. is an involuntary neurological reaction that can be changed
if the addict wants to change and will ask for and receive
C. is a biological reaction to a stimuli that can be altered
through learning a different reaction and consciously
repeating this new reaction over and over again
D. all the above
6.Individuals who have a solid grasp of right and wrong can use
their willpower to stop their addiction.
A. true
B. false
7.What is one of the main reasons why some families of addicts try
so hard to pick up the pieces after the addict relapses?
A. they are collecting evidence to confront their child’s denial
of the severity of their addiction
B. they have unconditional love for their family member.
C. guilt that they did something wrong in how they raised
their child which caused the addiction
D. they have a higher than average desire to live in a neat and
clean home
8.“Pairing off” with a new friend that an addict meets in recovery
is encouraged as a means of support.
A. true
B. false
9.Addicts should not take any psychiatric medication because it
will lead them back to their addiction.
A. true
B. false
10.Addicts between the ages of 18 and 26 are different from other
adult addicts in the following ways:
A. they do not use as large a quantity of the addictive
substance as older addicts
B. they can drink heavily and not have a hangover the next
C. their cortex is more developed than their limbic system
D. their limbic system is more developed than their cortex
Please see the next page for the answers (but do not look at the
answers until you have taken the test).
Post Test Answers
1. E
Every type of person in the world can have an addiction. The
strongest character, the most attractive, the most intelligent and
the most professional person could have an addiction if they have
been genetically prewired. The most down-and-out person and
a person who has had major losses do not have any more of a
potential to be an addict than anyone else in the world if they are
not prewired.
2. D
All addicts have stopped using their substance to prove to
everyone and to themselves that they are in control of their
use. This is just being abstinent and is not recovery. Even if they
remain abstinent over a long period of time, they are still just a
dry drunk. Recovery is the process of being totally honest with
yourself about who you are, especially with those aspects of
yourself that you do not like.
3. D
The 12 Steps of Recovery does not give you the answers as to
how to live your life and it is not an organized way to worship
God. It is a guideline by which an addict can start to repair the
damage caused by their active addiction.
4. D
Recovery is a process that occurs as the addict experiences life.
He cannot read it from a book. Being with others in recovery
provides the only classroom that can help the newcomer to find
healthy ways to deal with life.
5. D
The addict sets himself apart from everyone else in that when he
uses a substance and triggers off a chemical reaction in the brain
that makes him feel “right,” then he has to have this substance
again and again. Those who do not have an addictive disease can
use the same substance and get high but do not have the drive to
use this substance repetitively.
6. B
The only willpower that is helpful for an addict is the will to
want help. Until this occurs, treatment is a waste of time. The
addict has to want help in order for anyone to help him.
7. C
Guilt is one of the most powerful feelings we have. Though
we would like to think that we have separated ourselves from
our children, when they are struggling, we feel responsible. We
quickly see that our children are still a part of us.
8. B
Having a close therapeutic relationship with a peer is not a
problem but developing a personal relationship stops the safety
of being open and honest with the group as a whole.
9. B
There are some medications that an addict cannot take, especially
in the early phases of recovery, but most psychiatric medication
can be given when it is appropriate. Those who have a biological
depression or anxiety disorder have to have the appropriate
medication or these disorders will be major relapse risk factors.
Different parts of the brain develop before the other parts.
Unfortunately, the more primitive, life-sustaining part of the
brain develops first. The limbic system is necessary to deal with
many of the flight-or-fight reactions that is necessary to make
a person react instantly, without thinking, in order to prevent a
potentially lethal situation. This is also where humans have the
pleasure centers. From twelve years old until about twenty-six
years old, the limbic center may be the driving force as to how
someone reacts to certain stimuli. The limbic system does not
care about the consequences of that reaction.
Letting Go…
To “let go” does not mean to stop caring; it means I can’t do it for
someone else.
To “let go” is not to cut myself off; it’s the realization I can’t control
To “let go” is not to enable, but to allow learning from natural
To “let go” is to admit powerlessness, which means the outcome is
not in my hands.
To “let go” is not to try to change or blame another, it’s to make the
most of myself.
To “let go” is not to care for, but to care about.
To “let go” is not to fix, but to be supportive.
To “let go” is not to judge, but to allow another to be a human being.
To “let go” is not to be in the middle arranging all the outcomes, but
to allow others to affect their destinies.
To “let go” is not to be protective; it’s to permit another to face
To “let go” is not to deny, but to accept.
To “let go” is not to nag, scold, or argue, but instead to search out
my own shortcomings and correct them.
To “let go” is not to adjust everything to my desires, but to take each
day as it comes and cherish myself in it.
To “let go” is not to criticize and regulate anybody, but to try and
become what I dream I can be.
To “let go” is not to regret the past, but to grow and live for the
To “let go” is to fear less and love more.
The Twelve Steps
Step One
“We admitted that we were powerless over alcohol — that our lives
had become unmanageable.”
Who cares to admit complete defeat? Admission of powerlessness is
the first step in liberation. Relation of humility to sobriety. Mental
obsession plus physical allergy. Why must every A.A. hit bottom?
Step Two
“Came to believe that a Power greater than ourselves could restore us
to sanity.”
What can we believe in? A.A. does not demand belief; Twelve Steps
are only suggestions. Importance of an open mind. Variety of ways
to faith. Substitution of A.A. as Higher Power. Plight of the disillusioned. Roadblocks of indifference an prejudice. Lost faith found
in A.A. Problems of intellectuality and self-sufficiency. Negative
and positive thinking. Self-righteousness. Defiance is an outstanding
characteristic of alcoholics. Step Two is a rallying point to sanity.
Right relation to God.
Step Three
“Made a decision to turn our will and our lives over to the care of
God as we understood Him.”
Step Three is like opening of a locked door. How shall we let God
into our lives? Willingness is the key. Dependence as a means to
independence. Dangers of self-sufficiency. Turning our will over to
Higher Power. Misuse of willpower. Sustained and personal exertion
necessary to conform to God’s will.
Step Four
“Made a searching and fearless moral inventory of ourselves.”
How instincts can exceed their proper function. Step Four is an effort
to discover our liabilities. Basic problem of extremes in instinctive
drives. Misguided moral inventory can result in guilt, grandiosity, or
blaming others. Assets can be noted with liabilities. Self-justification
is dangerous. Willingness to take inventory brings light and new confidence. Step Four is beginning of lifetime practice. Common symptoms of emotional insecurity are worry, anger, self-pity, and depression. Inventory reviews relationships. Importance of thoroughness.
Step Five
“Admitted to God, to ourselves, and to another human being the
exact nature of our wrongs.”
Twelve Steps deflate ego. Step Five is difficult but necessary to sobriety and peace of mind. Confession is an ancient discipline. Without
fearless admission of defects, few could stay sober. What do we
receive from Step Five? Beginning of true kinship with man and God.
Lose sense of isolation. Receive forgiveness and give it; learn humility; gain honesty and realism about ourselves. Necessity for complete
honesty. Danger of rationalization. How to choose the person in
whom to confide. Results are tranquility and consciousness of God.
Oneness with God and man prepares us for following Steps.
Step Six
“Were entirely ready to have God remove all these defects of
Step Six necessary to spiritual growth. The beginning of a lifetime
job. Recognition of difference between striving for objective and
perfection. Why we must keep trying. “Being ready” is all-important.
Necessity of taking action. Delay is dangerous. Rebellion may be
fatal. Point at which we abandon limited objectives and move
toward God’s will for us.
Step Seven
“Humbly asked Him to remove our shortcomings.”
What is humility? What can it mean to us? The avenue to true
freedom of the human spirit. Necessary aid to survival. Value of egopuncturing. Failure and misery transformed by humility. Strength
from weakness. Pain is the admission price to new life. Self-centered
fear chief activator of defects. Step Seven is change in attitude which
permits us to move out of ourselves toward God.
Step Eight
“Made a list of all persons we had harmed, and became wiling to
make amends to them all.”
This and the next two Steps are concerned with personal relations.
Learning to live with others is a fascinating adventure. Obstacles:
reluctance to forgive; nonadmission of wrongs to others; purposeful
forgetting. Necessity of exhaustive survey of past. Deepening insight
results from thoroughness. Kinds of harm done to others. Avoiding
extreme judgments. Taking the objective view. Step Eight is the
beginning of the end of isolation.
Step Nine
“Made direct amends to such people wherever possible, except when
to do so would injure them or others.”
A tranquil mind is the first requisite for good judgment. Good timing
is important in making amends. What is courage? Prudence means
taking calculated chances. Amends begin when we join A.A. Peace of
mind cannot be bought at the expense of others. Need for discretion.
Readiness to take consequences of our past and to take responsibility
for well-being of others in spirit of Step Nine.
Step Ten
“Continued to take personal inventory and when we were wrong
promptly admitted it.”
Can we stay sober and keep emotional balance under all conditions?
Self-searching becomes a regular habit. Admit, accept, and patiently
correct defects. Emotional hangover. When past is settled with, present challenges can be met. Varieties of inventory. Anger, resentments,
jealousy, envy, self-pity, hurt pride all led to the bottle. Self-restraint
first objective. Insurance against “big-shot-ism.” Let’s look at credits
as well as debits. Examination of motives.
Step Eleven
“Sought through prayer and meditation to improve our conscious
contact with God as we understood Him, praying only for
knowledge of His will for us and the power to carry that out.”
Meditation and prayer main channels to Higher Power. Connection
between self-examination and meditation and prayer. An unshakable foundation for life. How shall we meditate? Meditation has no
boundaries. An individual adventure. First result is emotional balance. What about prayer? Daily petitions for understanding of God’s
will and grace to carry it out. Actual results of prayer are beyond
question. Rewards of meditation and prayer.
Step Twelve
“Having had a spiritual awakening as the result of these steps, we
tried to carry this message to alcoholics, and to practice these
principles in all our affairs.”
Joy of living is the theme of the Twelfth Step. Action its keyword.
Giving that asks no reward. Love that has no price tag. What is spiritual awakening? A new state of consciousness and being is received
as a free gift. Readiness to receive gift lies in practice of Twelve Steps.
The magnificent reality. Rewards of helping other alcoholics. Kinds
of Twelfth Step work. Problems of Twelfth Step work. What about
the practice of these principles in all our affairs? Monotony, pain,
and calamity turned to good use by practice of Steps. Difficulties of
practice. “Two-stepping.” Switch to “twelve-stepping” and demonstrations of faith. Growing spiritually is the answer to our problems.
Placing spiritual growth first. Domination and overdependence.
Putting our lives on give-and-take basis. Dependence upon God necessary to recovery of alcoholics. “Practicing these principles in all our
affairs”: Domestic relations in A.A. Outlook upon material matters
changes. So do feelings about personal importance. Instincts restored
to true purpose. Understanding is key to right attitudes, right action
key to good living.
The Twelve Traditions
Tradition One
“Our common welfare should come first; personal recovery depends
upon A.A. unity.”
Without unity, A.A. dies. Individual liberty, yet great unity. Key to
paradox: each A.A.’s life depends on obedience to spiritual principles.
The group must survive or the individual will not. Common welfare
comes first. How best to live and work together as groups.
Tradition Two
“For our group purpose there is but one ultimate authority — a
loving God as He may express Himself in our group conscience. Our
leaders are but trusted servants; they do not govern.”
Where does A.A. get its direction? Sole authority in A.A. is loving
God as He may express Himself in the group conscience. Formation
of a group. Growing pains. Rotating committees are servants of the
group. Leaders do not govern, they serve. Does A.A. have a real
leadership? “Elder statesmen” and “bleeding deacons.” The group
conscience speaks.
Tradition Three
“The only requirement for A.A. membership is a desire to stop
Early intolerance based on fear. To take away any alcoholic’s chance
at A.A. was sometimes to pronounce his death sentence. Membership
regulations abandoned. Two examples of experience. Any alcoholic
is a member of A.A. when he says so.
Tradition Four
“Each group should be autonomous except in matters affecting other
groups or A.A. as a whole.”
Every group manages its affairs as it pleases, except when A.A. as a
whole is threatened. Is such liberty dangerous? The group, like the
individual, must eventually conform to principles that guarantee
survival. Two storm signals — a group ought not do anything which
would injure A.A. as a whole, nor affiliate itself with outside interests.
An example: the “A.A. Center” that didn’t work.
Tradition Five
“Each group has but one primary purpose — to carry its message to
the alcoholic who still suffers.”
Better do one thing well than many badly. The life of our Fellowship
depends on this principle. The ability of each A.A. to identify himself
with and bring recovery to the newcomer is a gift from God … passing on this gift to others is our one aim. Sobriety can’t be kept unless
it is given away.
Tradition Six
“An A.A. group ought never endorse, finance, or lend the A.A. name
to any related facility or outside enterprise, lest problems of money,
property, and prestige divert us from our primary purpose.”
Experience proved that we could not endorse any related enterprise,
no matter how good. We could not be all things to all men. We saw
that we could not lend the A.A. name to any outside activity.
Tradition Seven
“Every A.A. group ought to be fully self-supporting, declining outside
No A.A. Tradition had the labor pains this one did. Collective
poverty initially a matter of necessity. Fear of exploitation. Necessity
of separating the spiritual from the material. Decision to subsist on
A.A. voluntary contributions only. Placing the responsibility of supporting A.A. headquarters directly upon A.A. members. Bare running
expenses plus a prudent reserve is headquarters policy.
Tradition Eight
“Alcoholics Anonymous should remain forever non-professional, but
our service centers may employ special workers.”
You can’t mix the Twelfth Step and money. Line of cleavage between
voluntary Twelfth Step work and paid-for services. A.A. could not
function without full-time service workers. Professional workers are
not professional A.A’s. Relation of A.A. to industry, education, etc.
Twelfth Step work is never paid for, but those who labor in service
for us are worthy of their time.
Tradition Nine
“A.A., as such, ought never be organized; but we may create service
boards or committees directly responsible to those they serve.”
Special service boards and committees. The General Service
Conference, the board of trustees, and group committees cannot
issue directives to A.A. members or groups. A.A.’s can’t be dictated
to- individually or collectively. Absence of coercion works because
unless each A.A. follows suggested Steps to recovery, he signs his
own death warrant. Same condition applies to the group. Suffering
and love are A.A.’s disciplinarians. Difference between spirit of
authority and spirit of service. Aim of our services is to bring sobriety
within reach of all who want it.
Tradition Ten
“Alcoholics Anonymous has no opinion on outside issues; hence the
A.A. name ought never be drawn into public controversy.”
A.A. does not take sides in any public controversy. Reluctance to
fight is not a special virtue. Survival and spread of A.A. are our
primary aims. Lessons learned from Washingtonian movement.
Tradition Eleven
“Our public relations policy is based on attraction rather than
promotion; we need always maintain personal anonymity at the level
of press, radio and films.”
Public relations are important to A.A. Good public relations save
lives. We seek publicity for A.A. principles, not A.A. members. The
press has cooperated. Personal anonymity at the public level is the
cornerstone of our public relations policy. Eleventh Tradition is a
constant reminder that personal ambition has no place in A.A. Each
member becomes an active guardian of our Fellowship.
Tradition Twelve
“Anonymity is the spiritual foundation of all our traditions, ever
reminding us to place principles before personalities.”
Spiritual substance of anonymity is sacrifice. Subordinating personal
aims to the common good is the essence of all Twelve Traditions.
Why A.A. could not remain a secret society. Principles come before
personalities. One hundred percent anonymity at the public level.
Anonymity is real humility.
“The Promises”
From the book Alcoholics Anonymous, chapter 6, “Into Action”
… If we are painstaking about this phase of our development, we will
be amazed before we are half-way through.
1. We are going to know a new freedom and a new happiness,
2. We will not regret the past, nor wish to shut the door on it,
3. We will comprehend the word serenity,
4. And we will know peace.
5. No matter how far down the scale we have gone, we will see how
our experience can benefit others.
6. That feeling of uselessness and self-pity will disappear.
7. W
e will lose interest in selfish things and gain insight into our
8. Self-seeking will slip away.
9. Our whole attitude and outlook will change.
10. Fear of people and economic insecurity will leave us.
11. W
e will intuitively know how to handle situations which used to
baffle us.
12. W
e will suddenly realize that God is doing for us what we could
not do for ourselves.
Are these extravagant promises? We think not. They are being
fulfilled among us — sometimes quickly, sometimes slowly. They will
always materialize if we work for them …